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Medications > All medications > Flashcards

All medications Flashcards

1
Q

Adrenaline- pharmacology

A

A naturally occurring alpha and beta-adrenergic stimulant.
Actions:
Increases HR by increasing SA node firing rate (Beta 1)
Increases conduction velocity through the A-V node (Beta 1)
Increases myocardial contractility (Beta 1)
Increases the irritability of the ventricles (Beta 1)
Causes bronchodilator (Beta 2)
Causes peripheral vasoconstriction (Alpha)

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2
Q

Adrenaline- indications

A

Cardiac arrest- VF/VT, Asystole, or PEA
Inadequate perfusion (cardiogenic or non-cardiogenic/non-hypovolaemic )
Bradycardia with poor perfusion
Anaphylaxis
Severe asthma- imminent life threat not responding to nebuliser therapy, or unconscious with no BP
Croup

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3
Q

Adrenaline- contraindication

A

Hypovolaemic shock without adequate fluid replacement

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4
Q

Adrenaline- precaution

A

Consider reduced doses for:
Elderly/frail patients
Patients with cardiovascular disease
Patients on monoamine oxidase inhibitors
Higher doses may be required for patents of beta blockers

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5
Q

Adrenaline- side effects

A

Sinus tachycardia
Supraventricular arrhythmias
Ventricular arrhythmias
Hypertension
Pupillary dilation
May increase size of MI
Feelings of anxiety/palpitations in the conscious patient

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6
Q

Aspirin- pharmacology

A

An analgesic, antipyretic, anti-inflammatory and anti platelet aggregation agent. Actions:
To minimise platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis in ACS
Inhibits synthesis of prostaglandins- anti-inflammatory actions

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7
Q

Aspirin- indication

A

ACS

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8
Q

Aspirin- contraindication

A

Hypersensitivity to aspirin/salicylates
Actively bleeding peptic ulcers
Bleeding disorders
Suspected dissecting aortic aneurysm
Chest pain associated with psychostimulant OD is SBP >160mmHg

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9
Q

Aspirin- precaution

A

Peptic ulcer
Asthma
Patients on anticoagulants

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10
Q

Aspirin- side effects

A

Heartburn, nausea, gastrointestinal bleeding
Increased bleeding time
Hypersensitivity reactions

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11
Q

Ceftriaxone- pharmacology

A

Cephalosporin antibiotic

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12
Q

Ceftriaxone- indications

A

Suspected meningococcal septicaemia
Severe sepsis

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13
Q

Ceftriaxone- contraindications

A

Allergy to cephalosporin antibiotics

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14
Q

Ceftriaxone- precautions

A

Allergy to penicillin antibiotics

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15
Q

Ceftriaxone- side effects

A

Nausea
Vomiting
Skin rash

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16
Q

Dexamethasone- pharmacology

A

A corticosteroid secreted by the adrenal cortex. Actions:
Relieves inflammatory reactions
Provided immunosuppression

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17
Q

Dexamethasone- indications

A

Bronchospasm:
- Severe (adult) or critical (paediatric) asthma
- Anaphylaxis as additional therapy
Moderate- severe croup
Acute exacerbation of COPD
Adult stridor (non-foreign body obstruction)

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18
Q

Dexamethasone- contraindications

A

Known hypersensitivity

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19
Q

Dexamethasone- precautions

A

Solutions which are not clear or are contaminated should be discarded

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20
Q

Dexamethasone- side effects

A

Nil of significance in above indication

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21
Q

Dextrose- pharmacology

A

A slightly hypertonic crystalloid solution
Composition:
Sugar- 10% dextrose
Water
Actions:
Provides a source of energy
Supplies body water

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22
Q

Dextrose- indications

A

Diabetic hypoglycaemia (BGL analysis < 4 mmol/L) in patients with an altered conscious state who are unable to self-administer oral glucose

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23
Q

Dextrose- contraindications

A

Nil of significance in the above indication

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24
Q

Dextrose- precautions

A

Nil of significance in the above indication

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25
Q

Dextrose- side effects

A

Nil of significance in the above indication

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26
Q

Droperidol- pharmacology

A

Dopamine antagonist- antipsychotic medication with sedative effects. Also blocks alpha adrenoceptors

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27
Q

Droperidol- indications

A

Moderate agitation or behavioural disturbance

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28
Q

Droperidol- contraindications

A

Nil

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29
Q

Droperidol- precautions

A

Elderly/frail patients are more susceptible to adverse effects
Parkinson’s disease. May experience worsening of Parkinson related symptoms
Lewy body dementia. May experience increase in agitation
QT prolongation has been reported rarely. Where possible provide ECG monitoring after sedation has been achieved

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30
Q

Droperidol- adverse effects

A

CNS: oversedation, dizziness
CVS: hypotension, tachycardia, QT prolongation
Extrapyramidal symptoms (rare)

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31
Q

Fentanyl- pharmacology

A

A synthetic opioid analgesic
Actions:
CNS effects:
Depression- leading to analgesia
Respiratory depression- leading to apnoea
Dependence (addiction)
Cardiovascular effects:
Decreases conduction velocity through the A-V node

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32
Q

Fentanyl- indications

A

Sedation to facilitate intubation
Sedation to maintain intubation
Sedation to facilitate transthoracic pacing
Sedation to facilitate synchronised cardioversion
CPR interfering patient- ALS
Analgesia IV/IN:
History of hypersensitivity or allergy to morphine
Known renal impairment/failure
Short duration of action desirable
Hypotension
Nausea and/or vomiting
Severe headache

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33
Q

Fentanyl- contraindications

A
  • History of hypersensitivity
  • Late second stage of labour
  • Serotonin syndrome
  • Monoamine oxidase inhibitors (MAOIs) within previous 14 days
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34
Q

Fentanyl- precautions

A

Patients on monoamine oxidase inhibitors
Impaired hepatic function
Current asthma
Known addiction to opioids
Elderly/frail patients
Respiratory depression, e.g. COPD
Rhinitis, rhinorrhea or facial trauma (IN route)

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35
Q

Fentanyl- side effects

A

Bradycardia
Apnoea
Rigidity of the diaphragm and intercostal muscles
Respiratory depression

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36
Q

Glucagon- pharmacology

A

A hormone normally secreted by the pancreas
Actions:
Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose

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37
Q

Glucagon- indications

A

Diabetic hypoglycaemia (BGL < 4mmol/L) in patients with an altered conscious state who are unable to self administer oral glucose
Anaphylaxis (adult) where patients remain hypotensive following adrenaline therapy with past history of heart failure or patients taking beta-blocker medication

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38
Q

Glucagon- contraindications

A

Nil of significance in the above indication

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39
Q

Glucagon- precautions

A

Nil of significance in the above indication

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40
Q

Glucagon- side effects

A

Nausea and vomiting (rare)

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41
Q

Glyceryl Trinitrate- pharmacology

A

Organic nitrate- relaxes smooth muscle
Venodilation promotes venous pooling and reduces venous return the the heart (reduces preload)
Ateriodilation reduces systemic vascular resistance and arterial pressure (reduced afterload)
Effects include:
Reduced myocardial oxygen demand
Reduced systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
Mild collateral coronary artery dilation may improve blood supply to ischaemic areas of myocardium
Mild tachycardia secondary to slight fall in BP
Preterm labour: uterine quiescence in pregnancy

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42
Q

Glyceryl Trinitrate- indications

A

Chest pain in acute coronary syndrome
Hypertension associated with acute coronary syndrome
Acute cardiogenic pulmonary oedema
Autonomic dysreflexia
Preterm labour (consult for GTN patch)

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43
Q

Glyceryl Trinitrate- contraindications

A

BP <100mmhg
HR > 150 bpm
HR < 50 (excluding autonomic dysreflexia)
Ventricular tachycardia
PDE5 inhibitors (current/recent use)
Riociguat (current use)
Bleeding in pregnancy

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44
Q

Glyceryl Trinitrate- precautions

A

Use lower doses (i.e 300mcg) in patients who are elderly (age > 60), have no previous exposure to GTN, or with recent MI as they may be more susceptible to adverse effects
Right ventricular MI or inferior STEMI with systolic BP < 160mmHg- use cautiously due to risk of severe hypotension from preload reduction
Preterm labour- concurrent use with other tocolytics

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45
Q

Glyceryl Trinitrate- adverse effects

A

CV: hypotension, tachycardia, bradycardia (occasionally)
CNS: headache, dizziness, syncope
Other: skin flushing

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46
Q

Glyceryl Trinitrate- significant interactions

A

Phosphodiesterase 5 (PDE5) inhibitors including avanafil (Spedra), sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). GTN increases the effects of PDE5 inhibitors resulting in profound hypotension. Do not administer GTN within:
12 hours since the last dose of avanafil OR
23 hours for sildenafil or vardenafil OR
48 hours for tadalafil
Riociguat (Adempas)- usd for pulmonary arterial hypertension. GTN increases the hypotensive effects of riociguat. Do not administer to patients currently taking this medication

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47
Q

Heparin- pharmacology

A

Anticoagulant
Inactivates clotting factors IIa (thrombin) and Xa by binding to antithrombin III

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48
Q

Heparin- indications

A

Acute STEMI

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49
Q

Heparin- contraindications

A

Known allergy or hypersensitivity
Active bleeding (excluding menses)
Oral anticoagulants
Bleeding disorders
History of Heparin induced Thrombocytopaenia (HIT)
Severe hepatic impairment/ disease, including oesophageal varices
Recent trauma or surgery (< 3 weeks)

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50
Q

Heparin- precautions

A

Renal impairment

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51
Q

Heparin- side effects

A

Bleeding
Bruising and pain at injection site
Hyperkalaemia
Thrombocytopaenia (mild to severe)

52
Q

Hydrocortisone- pharmacology

A

Corticosteroid with approximately equal glucocorticoid and mineralocorticoid

53
Q

Hydrocortisone- indications

A

Acute adrenal insufficiency

54
Q

Hydrocortisone- contraindications

A

Nil of significance

55
Q

Hydrocortisone- precautions

A

Nil of significance

56
Q

Hydrocortisone- adverse effects

A

Nil of significance when used for the approved AV indication

57
Q

Ipratropium Bromide- pharmacology

A

Anticholinergic bronchodilator
Actions:
Allows bronchodilation by inhibiting cholinergic bronchomotor tone (i.e. blocks vagal reflexes which mediate bronchoconstriction)

58
Q

Ipratropium Bromide- indications

A

Severe respiratory distress associated with bronchospasm
Exacerbation of COPD irrespective of severity

59
Q

Ipratropium Bromide- contraindications

A

Known hypersensitivity to atropine or its derivatives

60
Q

Ipratropium Bromide- precautions

A

Glaucoma
Avoid contact with eyes

61
Q

Ipratropium Bromide- side effects

A

Headache
Nausea
Dry mouth
Skin rash
Tachycardia (rare)
Palpitations (rare)
Acute angle closure glaucoma secondary to direct eye contact (rare)

62
Q

Ketamine- pharmacology

A

Anaesthetic agent with analgesic properties at lower doses.
Exact mechanism of action is unclear but primarily works as an antagonist at NMDA receptors. Ketamine may also interact with opioid, muscarinic and other receptors. Produces a trance-like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes

63
Q

Ketamine- indications

A

Intubation
Analgesia
Sedation:
Agitation
Patient movement during CPR

64
Q

Ketamine- contraindications

A

Suspected non-traumatic brain injury with severe hypertension (SBP > 180)

65
Q

Ketamine- precautions

A

May exacerbate cardiovascular conditions (e.g. uncontrolled hypertension, stroke, recent mI, cardiac failure) due to effects on HR and BP

66
Q

Ketamine- adverse effects

A

CV: hypertension, tachycardia
CNS: emergence reactions (e.g. vivid dreams, restlessness, confusion, hallucinations, irrational behaviour); increased skeletal muscle tone (may resemble seizures)
Respiratory: transient respiratory depression and apnoea (rare)
GI: nausea and vomiting
Other: injection site pain, lacrimation, hypersalivation, diplopia, nystagmus

67
Q

Methoxyflurane- pharmacology

A

Inhaled anaesthetic- produces analgesia at low concentrations, however the exact mode of action is unknown

68
Q

Methoxyflurane- indications

A

Analgesia

69
Q

Methoxyflurane- contraindications

A

Pre-existing renal disease
Known (or genetic susceptibility) to malignant hyperthermia

70
Q

Methoxyflurane- precautions

A

Patients should not be administered > 6 mL of methoxyflurane in a 24 hour period, due to increased risk of nephrotoxicity
To limit occupational exposure, methoxyflurane should not be administered in a confined space. Ensure adequate ventilation in the ambulance. Place used Penthrox inhalers in a closed plastic bag when not in use.

71
Q

Methoxyflurane- adverse effects

A

CNS: Dizziness, drowsiness
CV: Hypotension
GIT: Nausea and vomiting

72
Q

Midazolam- pharmacology

A

Short acting CNS depressant
Actions:
Anxiolytic
Sedative
Anti-convulsant

73
Q

Midazolam- indications

A

Status epilepticus
Sedation to maintain intubation
Sedation to facilitate intubation
Sedation to facilitate synchronised cardioversion
Sedation to facilitate transthoracic pacing
Sedation in the agitated patient
Sedation in the psychostimulant OD
Alcohol withdrawal syndrome

74
Q

Midazolam- contraindications

A

Known hypersensitivity to benzodiazepines

75
Q

Midazolam- precautions

A

Reduces doses may be required for the elderly/frail, patients with chronic renal failure, CCF or shock
The CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquilisers including alcohol
Can cause severe respiratory depression in patients with COPD
Patients with myasthenia gravis

76
Q

Midazolam- side effects

A

Depressed level of consciousness
Respiratory depression
Loss of airway control
Hypotension

77
Q

Morphine- pharmacology

A

An opioid analgesic. Actions:
CNS effects:
Depression (leading to analgesia)
Respiratory depression
Depression of cough reflex
Stimulation (changes of mood, euphoria or dysphoria, vomiting, pin-point pupils)
Dependence (addiction)
Cardiovascular effects:
Vasodilation
Decreases conduction velocity through the A-V node

78
Q

Morphine- indications

A

Pain relief
Sedation to maintain intubation
Sedation to facilitate intubation (where fentanyl not appropriate)

79
Q

Morphine- contraindications

A

History of hypersensitivity
Renal impairment/failure
Late second stage of labour

80
Q

Morphine- precautions

A

Patients on monoamine oxidase inhibitors
Acute alcoholism
Current asthma
Known addiction to opioids
Hypotension
Elderly/frail patients
Respiratory depression
Respiratory tract burns

81
Q

Morphine- side effects

A

CNS effects:
Drowsiness
Respiratory depression
Euphoria
Nausea, vomiting
Addiction
Pin-point pupils
Cardiovascular effects:
Hypotension
Bradycardia

82
Q

Naloxone- pharmacology

A

An opioid antagonist
Actions:
Prevents or reverses the effects of opioids

83
Q

Naloxone- indications

A

Altered conscious state and respiratory depression secondary to administration of opioids or related drugs

84
Q

Naloxone- contraindications

A

Nil of significance in the above indication

85
Q

Naloxone- precautions

A

If patient is known to be physically dependent on opioids, be prepared for a combative patient after administration
Neonates

86
Q

Naloxone- side effects

A

Symptoms of opioid withdrawal:
Sweating, goose flesh, tremor
Nausea and vomiting
Agitation
Dilation of pupils, excessive lacrimation
Convulsions

87
Q

Normal saline- pharmacology

A

An isotonic crystalloid solution
Composition:
Electrolytes (sodium and chloride in a similar concentration to that of extracellular fluid)
Action:
Increases the volume of the intravascular compartment

88
Q

Normal saline- indications

A

As a replacement in volume depleted-patients
Cardiac arrest secondary to hypovolaemia where the patient may be fluid responsive
To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive patient e.g. anaphylaxis, burns, sepsis
As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive patients (other than LVF). e.g. asthma
Fluid for diluting and administering IV drugs
Fluid TKVO for IV administration of emergency drugs

89
Q

Normal saline- contraindications

A

Nil of significance in the above indication

90
Q

Normal saline- precautions

A

Nil of significance in the above indication

91
Q

Normal saline- side effects

A

Nil of significance in the above indication

92
Q

Olanzapine- pharmacology

A

Atypical antipsychotic- antagonist at multiple receptor sites, particularly serotonin, dopamine, and histamine

93
Q

Olanzapine- indications

A

Mild agitation

94
Q

Olanzapine- contraindications

A

Nil

95
Q

Olanzapine- precautions

A

Olanzapine may be less effective if patient agitation is due to drug intoxication (especially stimulants) or alcohol withdrawal. Benzodiazepines are considered first-line agents in these patients.
Elderly/frail patients and children are more susceptible to adverse effects

96
Q

Olanzapine- adverse effects

A

CNS: Sedation, dizziness
Other: Extrapyramidal symptoms and QT prolongation are unlikely when administered at the approved doses

97
Q

Ondansetron- pharmacology

A

Serotonin antagonist- exact mode of action is not fully understood. Release of serotonin is thought to trigger a vomiting reflex in both the peripheral (GIT) and central nervous system

98
Q

Ondansetron- indications

A

Undifferentiated nausea and vomiting
Prophylaxis where vomiting could be clinically detrimental (e.g. spinally immobilised, penetrate g eye trauma)

99
Q

Ondansetron- contraindications

A

Apomorphine

100
Q

Ondansetron- precautions

A

Pregnancy 1st trimester- consult with receiving hospital
Congenital long QT syndrome- ondansetron causes QT prolongation (dose-dependent effect) and increases the risk of Torsades de pointes in patients with a prolonged QT interval (QTC > 500 ms)
Severe hepatic disease (e.g.cirrhosis) - limit total daily dose to a maximum of 8mg
Ondansetron ODT may contain aspartame which should be avoided in patients with pheylketonuria. Ondansetron injection can be administered if appropriate.

101
Q

Ondansetron- adverse effects

A

CNS: Headache, dizziness
CV: QT prolongation (rare)
GI: Constipation
Other: Visual disturbance, including transient loss of vision (rare, associated with rapid IV administration)

102
Q

Oxytocin- pharmacology

A

Synthetic pituitary hormone- stimulates uterine muscle contraction. Uterine atony is the most common cause of PPPH

103
Q

Oxytocin- indications

A

Primary postpartum haemorrhage (PPPH)

104
Q

Oxytocin- contraindications

A

None, provided all babies have been delivered prior to administration

105
Q

Oxytocin- precautions

A

Nil

106
Q

Oxytocin- adverse effects

A

Nausea and vomiting

107
Q

Paracetamol- pharmacology

A

Analgesic and antipyretic- exact mechanism of action is unclear; thought to inhibit prostaglandin synthesis in the CNS

108
Q

Paracetamol- indications

A

Mild pain, or pain relief in combination with other analgesics
Headache

109
Q

Paracetamol- contraindications

A

Children < 1 month of age

110
Q

Paracetamol- precautions

A

Hepatotoxicity can occur with overdose
Do not administer if paracetamol has already been given within past 4 hours, or if total paracetamol intake within past 24 hours exceeds 4g (adults) or 60mg/lg (children)
Risk of hepatotoxicity is increased in the following circumstances:
Impaired hepatic function or liver disease
Elderly/frail patients
Malnourishment

111
Q

Paracetamol- adverse effects

A

Hypersensitivity reactions including severe skin rashes (rare)
Haematological reactions (rare)
Hypotension has been reported with IV infusion, particularly in critically ill patients

112
Q

Prochlorperazine- pharmacology

A

Dopamine antagonist- antiemetic effects are primarily due to D2 receptor blockade. Also acts on other neurotransmitter systems including histamine, cholinergic and a-adrenergic receptors

113
Q

Prochlorperazine- indications

A

Nausea and vomiting in patient >21 years of age; sepcifically for
- Known allergy or C/I to ondansetron
- Vestibular nausea
Headache (irrespective of nausea/vomiting)

114
Q

Prochlorperazine- contraindications

A

CNS Depression (i.e. unconscious or severely intoxicated)
Patients < 21 years of age
Children and young adults are more susceptible to extrapyramidal reactions with prochlorperazine

115
Q

Prochlorperazine- precautions

A

Elderly patients- more susceptible to adverse effects
Parkinson’s disease- can worsen symptoms of parkinson’s disease, avoid if possible

116
Q

Prochlorperazine- adverse effects

A

CNS: Sedation, blurred vision
CV: Postural hypotension, QT prolongation (rare)
Other: Extrapyramidal reactions

117
Q

Salbutamol- pharmacology

A

A synthetic beta adrenergic stimulant with primarily beta 2 effects. Actions: causes bronchodilation

118
Q

Salbutamol- indications

A

Respiratory distress with suspected bronchospasm:
Asthma
Severe allergic reaction
COPD
Smoke inhalation
Oleoresin capsicum spray exposure

119
Q

Salbutamol- contraindications

A

Nil of significance in the above indications

120
Q

Salbutamol- precautions

A

Large doses of Salbutamol have been reported to cause intracellular metabolic acidosis

121
Q

Salbutamol- side effects

A

Sinus tachycardia
Muscle tremor

122
Q

Tenecteplase- pharmacology

A

Fibrinolytic, a modified form of tissue plasminogen activator (tPA) that binds to fibrin and converts plasminogen to plasmin

123
Q

Tranexamic Acid- pharamcology

A

Antifibrinolytic- binds to plasminogen, decreasing conversion to plasmin, and thereby prevents fibrin degradation

124
Q

Tranexamic Acid- Indications

A

Severe postpartum haemorrhage
Severely injured patients at risk of acute traumatic coagulopathy

125
Q

Tranexamic Acid- Contrainidcations

A

Injury occured >2 hours prior to administration

126
Q

Tranexamic Acid- Precautions

A

Rapid administration increases the risk of adverse effects

127
Q

Tranexamic Acid- Adverse effects

A

CNS: Seizures
CVS: Hypotension, dizziness
GIT: Nausea, vomiting, diarrhoea

Medications (2 decks)

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